The start of 2024 ushered in welcomed news for millions of Californians—a historic rate hike in Medi-Cal coverage to improve health-care access for enrollees. As a leading physician, these changes may affect your practice… and your profitability. There’s a lot of information for providers to digest about this initiative. Here, we’re breaking down the highlights.
WHAT’S CHANGING?
Rates have increased to no less than 87.5% of the lowest Medicare rate for targeted services in California. Under the leadership of the California Medical Association (CMA), this monumental initiative was the result of the Managed Care Organization (MCO) Tax, a critical component of the 2023-24 budget deal created by the Coalition to Protect Access to Care.
WHO’S INCLUDED?
The first part of the initiative, which encompasses a broad spectrum of health needs, focuses on the following services:
- Primary care
- Obstetric
- Mental health
Eligible providers include a wide range of health care professionals, including these and others:
- Physicians
- Physician Assistants
- Nurse Practitioners
WHEN IS THIS HAPPENING?
There are two phases to the implementation of this plan:
- Phase One: This phase (which includes primary care, obstetrics, and mental health) launched on January 1, 2024.
- Phase Two: Starting January 1, 2025, the rate adjustments will expand to other areas such as specialty care, community/hospital outpatient procedures, family planning, and more.
The main goal of this plan is to increase Medi-Cal members’ access to quality care while offering more compensation to providers to treat more of these patients. Further details of this plan can be found on the California Department of Health Care Services (DHCS) website.
